Ileus resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Synonyms and keywords:
Overview
Ileus is defined as reduction in intestinal motility, which is either due to an obstruction (mechanical ileus) or due to intestinal paralysis (functional ileus). Reduction or cessation of intestinal peristalsis prevent effective transmission of intestinal content which leads to constipation and abdominal distension, which are known as typical symptoms of ileus. Nevertheless, onset and severity of symptoms are depended on extent and location of obstruction in mechanical ileus. Although proximal obstructions are presented acutely with nausea, vomiting, abdominal pain and obstination, more distal involvements usually take longer to become symptomatic.
Causes
Life Threatening Causes
Untreated ileus can lead to intestinal tissue ischemia, which elevates the risk of perforation and subsequently life threatening peritonitis.[1][2]
Common Causes of Functional Ileus
- Reflectory ileus due to abdominal, pelvic or retroperitoneal surgeries[1]
- Medications such as narcotics, anticholinergics, calcium channel blockers and antipsychotics[2][3]
- General anaesthesia[1]
- Hypokalemia[3]
- Diabetes Mellitus[3]
- Intestinal hypoperfusion[3]
- Pancreatitis
Common Causes of Mechanical Ileus
- Tumors[3]
- Hernia
- Infections or inflammations that affect the bowel wall (eg, diverticulitis])[3]
- Fecal impaction[3]
- Intussusception
- Adhesion (eg, due to a previous surgery)[3]
- Volvulus (eg, sigmoid volvulus)
Diagnosis
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Treatment
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Do's
- The content in this section is in bullet points.
Don'ts
- Don't use CT scan with barium contrast due to it's irritative nature, specifically in presence of perforation.[3]
- Don't use vagolytic agents such as butylscopolamine for pain control, due it's antiperistaltic effect.[3]
References
- ↑ 1.0 1.1 1.2 Luckey A, Livingston E, Taché Y (2003). "Mechanisms and treatment of postoperative ileus". Arch Surg. 138 (2): 206–14. doi:10.1001/archsurg.138.2.206. PMID 12578422.
- ↑ 2.0 2.1 Zeinali F, Stulberg JJ, Delaney CP (2009). "Pharmacological management of postoperative ileus". Can J Surg. 52 (2): 153–7. PMC 2663489. PMID 19399212.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Vilz TO, Stoffels B, Strassburg C, Schild HH, Kalff JC (2017). "Ileus in Adults". Dtsch Arztebl Int. 114 (29–30): 508–518. doi:10.3238/arztebl.2017.0508. PMC 5569564. PMID 28818187.